Group Power for Medical Tourists

The most important tip I can give medical tourists is to join the Traveling4Health Community – that’s a given.

Our mission is to raise the standard of care and reduce the risk for patients traveling for treatments.

One of the tools available to members is the Traveling4health Press Badge.  Watch this video “Medical Tourism Tip for Medical Tourists… a powerful tool for medical tourists”.

When you’re talking about making connections outside your home country, nothing matters as much as the reputation of those with whom you have an opportunity to connect on a personal or business level.

As a member of the Traveling4Health Community, you have the opportunity to build a track record of trust with providers BEFORE making any “buying” or relationship decisions by directly communicating on a secure platform where each party has total control of their own information.

When you travel, make sure you carry your Traveling4Health Press Badge.  I’m going to tell you how to use it and then I’m going to tell you why this works so well.

Click here to buy your Press Badge

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What is a Medical Tourism Facilitator?

Medical Tourism Facilitators – There are two business models

The Patient Broker Model

The Patient Broker Model is similar to the travel agent model.  It is typically used by facilitators whose prior professional orientation has not been in the insurance or medical field.  Typically the broker receives a referral commission from the healthcare provider and has minimal to no involvement in the process and outcome.

Interaction with the patient is limited to assistance in booking the trip or trip package and selection of a medical facility or provider.  In some cases it may be limited to customer service.

This model is suited for patients who may not have complicated medical issues or patients who are confident in their problem resolution skills, e.g., well-traveled people who know the destination environment and know the language.

It’s important to note that this “travel agent model” only works abroad because in the U.S. it is illegal to give commissions to anyone who refers patients.

The TPA/Case Management Model

The second model is the TPA/Case Management Model whereby the facilitator’s orientation has been from the health insurance and medical service delivery environment.  This model uses business and medical process management principles that are standards for healthcare and insurance operation in the U.S. and abroad.

This model is applicable to more complex medical cases where more precise estimating and clinical course of care are of paramount importance.  This approach stresses patient safety, business management, cost-containment and a care-continuum between referring and treating physicians as being essential to the integrity of the transaction and clinical outcome.

Travel for Treatment facilitators who use this model typically charge a fee that is either a flat case rate or a percentage of case costs.  Range of such fees:  You will find anywhere from 15 to 25% or flat fees in the range of $1,500 to $2,500 per case.

The medical traveller should recognize that expert management is critical to his safety and to streamlining the administrative and financial issues that are associated with a more complicated case such as neuro surgery, cancer care, and cardiac surgery.

A Hospital administrator shares his perspective

We asked the following questions of a hospital administrator who deals directly with international patients, to give us his perspective on both patient brokers and TPAs.

Because Costa Rica is a mecca destination for medical travelers in the Western Hemisphere, we chose to interview Brad Cook, Director of the International Department of Hospital Clínica Bíblica in Costa Rica.

1.            What have you noticed is the difference in patient experience between dealing with a patient broker vs. a third party administrator (TPA) or 3rd party payer?

Says Cook, “It’s not a black and white issue because there are a lot of patient brokers with a range of different approaches to customer care; from hands on to hands off.

There are some patient brokers who are only interested in finding the cheapest option, not necessarily in finding the best quality.  I know quite a few of those, so in that case, the lack of customer service and case management is definitely not in the best interest of the patient.

On the other hand, there are patient brokers who really do their homework and are similar to TPA’s in the type of staff they have, like a nurse or doctor on the board.

From what I’ve seen, patients are going to get a lot more support from a TPA.  TPA’s want a lot more information from the hospital as far as statistics like death rates, complications and number of surgeries performed, and I think overall this indicates the patient is going to be given the best choice.

Usually the contract a TPA has in place with the hospital is a lot more detailed.  They make sure that the hospital is up to U.S. standards, and they do a lot more follow-up while the patient is here and after the patient returns home.

2              In your opinion, which referral channel is better for the hospital and the patient?

Says Cook, “On complex, high-risk procedures a TPA referral channel is better for the patient because of the risk of complications.  Most of our patients are self-pay, and if there is a complication we are concerned that the patient may not be able to afford the complication.  With a TPA the process is easier for the patient and for the hospital.

If there is a complication it’s going to be a lot less expensive for the patient to deal with it here than it would be in the States.  Should there be a complication we charge the same price as we would a Costa Rican patient.

3.            When dealing with “patient brokers”, does the lack of external case management control  diminish the patient experience?

Says Cook, “We do get feedback from patients who feel forgotten about, so on that level working with a TPA case management agency is likely to result in a better experience for a patient.

4.            When you see a self-pay patient who comes with a broker only, is it a license to overcharge that patient?

Says Cook, “When we create a package price that’s the price we give the broker and that’s the price we give the patient if they come to us directly.  We have noticed, from comments about prices made by patients, that some patients are paying their brokers higher prices than the prices we quoted the broker.  TPA’s tend to do a better job of negotiating the best prices for the patient.

I would also emphasize that one of the best reasons to choose HCB is our International Department since we have over 15 years dealing with International patients and are often invited to speak and train other hospitals in the region on the inner workings of international patient assistance.”

Brad Cook is a contributor to the Traveling4Health ebook “How to Plan a Successful Medical Tourism Trip”.

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Understanding Medical Malpractice in Foreign Countries

Dick Atkins, owner of Dick Atkins, Esq. is a Philadelphia lawyer who specializes in assisting companies and individuals on legal issues in foreign countries.

He is an owner of International Recoveries, LLC and lectures at travel insurance conventions.   He is on the Board of Directors for the United States Travel Insurance Association.

Atkins paints a picture of both the good news and the bad.  According to Atkins the good news is that there are some very good foreign hospitals where no medical malpractice suits have ever been filed.

On the other hand, the bad news is that should you desire to file a medical malpractice suit the odds are stacked against you and realistically not worth the time and expense to do so.

Read:  Atkins on “Legal Rights Affecting Medical Tourists”

Low Ratio of Medical Malpractice Cases Filed

Atkins often speaks on legal assistance for medical tourists at conferences, for example in November, 2010 at the International Travel Insurance conference in Istanbul, Turkey.   In 2009 he was on a panel discussing the legal rights of medical tourists for the 2009 conference.

“In many countries the care provided and the expertise of the doctors is very high and there aren’t many instances of malpractice in the really good hospitals,” said Atkins, “The services are excellent and indeed a bargain.”

“Bumrungrad Hospital in Thailand presented at one of the conferences where I spoke,” said Atkins, “and I checked thoroughly to see how many law suits were recorded against them and apparently there were none.  Everyone I checked with gave them the highest ratings and I couldn’t find anything wrong going on.”

Malpractice Options Abroad

I get calls from medical tourists and I tell them what the issues and problems are.  There have been a couple of incidents in hospitals in Costa Rica and also in the Dominican Republic but in each of those cases there wasn’t anything viable that could be done.  It was too costly and the system was too complicated to recoup compensation and the amount of any award would be too little.

In addition to all of those things almost everyone is required to sign a very comprehensive release form that tells them the dangers of having a procedure and that certain things can go wrong and/or paperwork that makes a patient agree to bring any law suit only in that country and not anywhere else,” said Atkins”, or other protections for the hospitals that make it very difficult for the individual or the medical providers or intermediaries who set up the trips to benefit from the process of bringing a law suit.

It is very complicated, very expensive and the realistic thing is that it’s almost impossible to sue.  In other countries lawyers don’t offer their services on a contingency basis so you will have to pay your lawyer up front maybe $100 or $200 or more per hour and it can go on for hundreds of hours.

Because of what patients are required to sign, because of the system and because of the lawyers want the money up front it is virtually impossible for suing to be worthwhile.

Foreign Hospital Malpractice Policy

Some foreign hospitals have their own medical malpractice policies.  And according to Atkins you get compensated according to what they are willing to give you.  There’s no point in suing for more.

Cases of malpractice are governed by the country’s law.   “If a person is injured or a life is loss, any awarded compensation is based on the financial value of a person’s life in that country,” said Atkins.

“If there is a clear case of malpractice in the U.S. where a person is permanently injured or died at a medium age, “explained Atkins, “a person might get a couple of million as a settlement.  But in a foreign country for the same claim you might get $10,000 to $20,000 or even less.”

“In virtually every country, with a couple of exceptions, for example Israel,” said Atkins , “the laws are such that it is virtually impossible to get a significant malpractice verdict.   According to Atkins, Israel has a system of much higher awards in civil negligence cases.

Barriers to Bringing a Law Suit in a Foreign Country

I was recently involved in a case in Thailand where there were some severe injuries,” said Atkins, “not medical malpractice.  The judge required that the individual return to Thailand for court appearances even if the individual wasn’t well enough to travel according to advice from his or her doctor.”

“If an insurance company wants to get their money back they may have to fly to Thailand for court appearances as well,” added Atkins.

“The system can take many, many years and the money that you may be awarded will be so low in comparison to the United States that it’s not economically viable to bring the law suit there,” said Atkins.

Advice to Medical Tourists

It’s important for people who are going abroad for medical treatment to make sure they have checked out the reputation of a hospital or to rely on a professional medical tourism facilitator who has checked out the hospital background and reputation.

Don’t just show up in town.  “It would be so dangerous for somebody just to go online and arbitrarily pick some place to go without any advice and assistance.  It’s so important to have somebody there to meet them and orient them to the hospital and recuperation facilities.  They must have some kind of insurance and assistance if something goes wrong,” concluded Atkins.

View the profile of Dick Atkins

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Medical Trip and Medical Procedure Insurance for Medical Tourists

Why is it so hard to find?

Standard Medical Travel Insurance

Travel for medical treatment is not covered by routine medical travel insurance because it specifically excludes coverage of “pre-existing” conditions and traveling for treatment.  Consequently, it will not cover any treatment expenses, or cost of air ambulance in the event emergency medical evacuation to home country is needed.

Only four companies in the world offer medical travel insurance that doesn’t exclude people traveling for treatment, and only two of those are in the U.S. and therefore available to U.S. citizens.

We interviewed Jim Krampen, co-founder and Executive Officer of Seven Corners Inc., the only company offering this product online and available immediately – the whole application process takes less than five minutes.

“Our policy does not exclude traveling for treatment,” said Krampen, “We know you are going for that purpose.  All other travel policies anywhere in the world — they will not cover you if you are traveling for treatment.”

“We offer a comprehensive Medical Tourism Insurance that includes Medical Complications Coverage, Trip Cancellation Coverage, Medical Coverage, Medical Evacuation Coverage – all in one plan,” he said.

A Unique Medical Complication Insurance

“It is the first plan of its type to cover medical complications after treatment while abroad or after your return home,” said Krampen, “The name of the product is Bordercross Worldwide.”

Rates are in direct relationship to the procedure risk and foreseeable complications cost.  This type of coverage is capped at a fixed benefit amount.

Medical Complication Insurance vs. Malpractice Insurance.

Medical Complication Insurance is not insurance for medical malpractice, which is an issue of liability.

A lot of consumers tend to think they are one and the same.  Obviously if you have a complication you can sue your doctor, but that does not mean that malpractice was involved,” said Krampen, “However Medical Complication Insurance does not correct the surgical procedure if there has been malpractice,”

Cost for Medical Trip and Procedure Insurance

The cost of an individual policy will depend on the cost of your trip and medical treatment and your selection of $10,000, $20,000 or $50,000 in medical complication coverage.

In general if it cost you $20,000 for everything — your travel, your accommodations, your procedure, etc., and you want to buy the best coverage they offer to cover the complications, the $50,000 coverage, it’s going to be about 12% so that’s $2,400.
“So you would pay $20,000 to your facilitator and then another $2,400 to us to cover everything; the trip cancellation, the travel medical and the complications insurance,” said Krampen, “If you were only to buy the $10,000 complication coverage it would be closer to about 7%.”

Insurance products can only be sold by licensed agents.  “So how we save people money is that we distribute the product through the tour and facilitator websites whose prices are less than those quoted on our wholesale site,” said Krampen.

“It’s 10% cheaper for you to go through a facilitator than if you went directly to Seven Corners, “ explained Krampen, “And we prefer that people go through a medical tourism facilitator so that the facilitator can explain everything to their clients.”

“You can call us and we can walk you through how to find a facilitator who knows how this works,” said Krampen, “and we participating facilitators listed on our site.”

The Value of Medical Complication Insurance for Medical Tourists

A story shared by Krampen:

“One of our former clients is a woman in her mid-50’s, employed by a very small employer who did not offer health insurance.  When she was 19 she was in a car accident and fractured her hip.

She’d always had issues with her hip and finally she couldn’t take it anymore.  Her hip deteriorated more and more so she looked into medical tourism and found a facilitator to get her to India.

She and her husband went to India for a hip replacement that cost a total $13,000.  The same operation in Texas would have cost her $60,000.  She purchased complication medical insurance from us at the $10,000 maximum.

The trip went fine, she got the surgery and she came back home.  Two weeks later she started running a high fever, doesn’t know what’s going on and the doctor says she has an infection.  It ended up being a staph infection but it was untreatable because the staph infection was on the stainless steel hip device.

So we paid for the procedure in Texas where they opened her back up and they cleaned off and sterilized the stainless steel device and got rid of the staph.

Unfortunately the corrective procedure cost $30,000.  In hindsight, of course, she would have been wise to select the $50,000 complication insurance which would have covered everything.”

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